Investigate the incorporation of an antibiotic in bone cement using liposomes (a drug delivery system) with the potential to promote osseointegration at the bone cement interface whilst maintaining antibiotic elution, anti-microbiological efficacy and cement mechanical properties. Prosthetic joint infection and aseptic loosening are associated with significant morbidity. Antibiotic loaded bone cement is commonly used and successfully reduces infection rates; however, there is increasing resistance to the commonly used gentamicin. Previous studies have shown gentamicin incorporated into bone cement using liposomes can maintain the cement's mechanical properties and improve antibiotic elution. The phospholipid phosphatidyl-l-serine has been postulated to encourage surface osteoblast attachment and in a liposome could improve osseointegration, thereby reducing aseptic loosening. Preliminary clinical isolate testing showed excellent antimicrobial action with amoxicillin therefore the study aims were to test amoxicillin incorporated into bone cement using liposomes containing phosphatidyl-l-serine in terms of antibiotic elution, microbiological profile and mechanical properties. Amoxicillin was encapsulated within 100nm liposomes containing phosphatidyl-L-serine and added to PMMA bone cement (Palacos R (Heraeus Medical, Newbury, UK)). Mechanical testing was performed according to Acrylic Cement standards (ISO BS 5833:2002). Elution testing was carried out along with microbiological testing utilising clinical isolates.Objectives
Methods
Compare clinical outcomes following staged revision arthroplasty for periprosthetic joint infection (PJI) secondary to either multidrug resistant (MDR) bacteria or non-MDR (NMDR) bacteria. Retrospective analysis of a prospectively collected bone infection database. Adult patients diagnosed and treated for hip or knee PJI, between January 2011 and December 2014, with minimum one-year follow-up, were included in the study. Patients were divided into two groups: MDR group (defined as resistance to 3 or more classes) and N-MDR group (defined as acquired resistance to two classes of antibiotic or less). The Charlson Comorbidity Index was used to stratify patients into low, medium and high risk. The diagnosis of PJI, and any recurrence following treatment, was made in accordance with the Musculoskeletal Infection Society criteria. Failure was defined as recurrence of infection necessitating implant removal, excision arthroplasty, arthrodesis or amputation.Aim
Method
Review our unique experience in the management of 29 consecutive casualties who survived open pelvic fractures following a blast mechanism. Retrospective study utilising a prospectively collected combat trauma registry. Records of UK Service Personnel sustaining open pelvic fractures from an explosion from Aug 2008 – Aug 2010 identified. Casualties who survived to be repatriated to the Royal Centre for Defence Medicine, University Hospital Birmingham were selected for further study. The median New Injury Severity Score (NISS) was 41. Mean blood requirement in the first 24 hours was 60.3 units. In addition to their orthopaedic injury, 6 (21%) had an associated vascular injury, 7(24%) had a bowel injury, 11 (38%) had a genital injury and 7(24%) had a bladder injury. 8 (28%) fractures were managed definitively with external fixation, and 7 (24%) fractures required internal fixation. Of those patients who underwent internal fixation, 5 (57%) required removal of metalwork for infection. Faecal diversion was performed on 9 (31%) casualties. Median length of stay was 70.5 days, and mean total operative time was 29.6 hours. At a mean 20.3 months follow-up, 24 (83%) were able to ambulate, and 26 (90%) had clinical and radiological evidence of pelvic ring stability.Aim/Purpose
Methods and Results
The aim of this study is to review our unique experience in the management of 29 consecutive casualties who survived open pelvic fractures following a blast mechanism, in order to determine the injury pattern, clinical management and outcome of these devastating injuries. All patients were serving soldiers who were injured whilst on operations in Afghanistan. The median New Injury Severity Score (NISS) was 41. Mean blood requirement in the 1st 24 hours was 60.3 units. In addition to their orthopaedic injury, 6 (21%) had an associated vascular injury, 7(24%) had a bowel injury, 11 (38%) had a genital injury and 7(24%) had a bladder injury. 8 (28%) fractures were managed definitively with external fixation, and 7 (24%) fractures required ORIF. Of those patients who underwent ORIF, 4 (57%) required removal of metalwork for infection. Faecal diversion was performed on 9 (31%) casualties. Median length of stay was 70.2 days, and mean total operative time was 29.6 hours. At a mean 20.3 months follow-up, 24 (83%) were able to ambulate, and 26 (90%) had clinical and radiological evidence of pelvic ring stability. The “Global War on Terror” has resulted in incidents that were previously confined exclusively to conflict areas can now occur anywhere, and surgeons who are involved in trauma care may be required to manage similar injuries from terrorist attacks. Our study clearly demonstrates that the management of this injury pattern is extremely resource intensive with the need for significant multi-disciplinary input. Given the nature of the soft tissue injury, we would advocate an approach of minimal internal fixation in the management of these fractures. With the advent of emerging wound and faecal management techniques, we do not believe that faecal diversion is mandated in all cases.
This study was undertaken to assess for equivalence or superiority in tendon reconstruction techniques. This is an A statistically significant difference was shown between all the techniques by analysis of variance. This will guide clinical application of these techniques. The use of bone tunnels, through which the flexor hallucis longus tendon can be passed, were found to be biomechanically superior, with regard to ultimate load to failure, to either bone anchors or end-to-end tendon suture techniques. Interference screws were found to have a large range in their ultimate load suggesting a lack of consistency in the results. The mean of the bone tunnel group (482.8N, SD 83.6N) is significantly (p < 0.01) higher than the mean of the bone anchor group (180.2N, SD 19.3N), which is, in turn, significantly (p < 0.01) higher than the mean of the Bunnell group (73.7N, SD 20.9N). This study is larger than any previous study found in the literature with regard to number of study groups and allows the techniques to be compared side by side.
Patients with fractured neck of femur have historically received less attention than they deserve and have high morbidity and mortality. Literature suggests that speed to theatre reduces length of in-patient stay and complications. Using patients' expressed needs as a basis to redesign the service, a multidisciplinary project team mapped the current process of admission, simulated and mapped an ideal process. This resulted in a fast admission process for patients with suspected fractured proximal femur. Paramedics call a trauma coordinator based on the specialist ward who meets the patient at the door of the Emergency Department, escorting them to X-ray. The fracture is confirmed remotely by an experienced surgeon using PACS. Patients are taken to an optimisation area in the theatre complex for consultant orthopaedic and anaesthetic assessment prior to surgery the same day (utilising spare time on elective and trauma lists), or early the following day. Fascia-iliaca blocks are provided by trauma coordinators to improve pain control and reduce sedative effects of opiates, aiding early mobilisation. Measures include time to theatre, length of stay, and patient experience. Meaningful mortality and morbidity data will become available later.Background
Methodology
